| NPI | 1306377320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMKRISHNA SURENDRAN Md 248-759-5460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI RS075798) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: MI SR079574) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-03-22 |